Controversies and Advances in Gestational Diabetes—An Update in the Era of Continuous Glucose Monitoring

Abstract

Diabetes in pregnancy, both preexisting type 1 or type 2 and gestational diabetes, is a highly prevalent condition, which has a great impact on maternal and fetal health, with short and long-term implications. Gestational Diabetes Mellitus (GDM) is a condition triggered by metabolic adaptation, which occurs during the second half of pregnancy. There is still a lot of controversy about GDM, from classification and diagnosis to treatment. Recently, there have been some advances in the field as well as recommendations from international societies, such as how to distinguish previous diabetes, even if first recognized during pregnancy, and newer diagnostic criteria, based on pregnancy outcomes, instead of maternal risk of future diabetes. These new recommendations will lead to a higher prevalence of GDM, and important issues are yet to be resolved, such as the cost-utility of this increase in diagnoses as well as the determinants for poor outcomes. The aim of this review is to discuss the advances in diagnosis and classification of GDM, as well as their implications in the field, the issue of hyperglycemia in early pregnancy and the role of hemoglobin A1c (HbA1c) during pregnancy. We have looked into the determinants of the poor outcomes predicted by the diagnosis by way of oral glucose tolerance tests, highlighting the relevance of continuous glucose monitoring tools, as well as other possible pathogenetic factors related to poor pregnancy outcomes.

Paeoniflorin attenuates gestational diabetes via Akt/mTOR pathway in a rat model

“…When the insulin secreted by the pancreas is not enough to control normal blood glucose levels, the blood glucose level rises, and the constant high levels of blood glucose contribute to the development of GDM (3). GDM is closely related to an increased frequency of fetal macrosomia, which may increase the incidence of development of cardiovascular disease, obesity, and diabetes for the descendant (4,5).…”

Value of HbA1c in Obese Women with Gestational Diabetes

“…It is likely that an increase or even a stable HbA1c may represent worsening glycemic control during pregnancy, which may contribute to adverse outcomes. However, prior studies of early treatment for elevated HbA1c or gestational diabetes have not demonstrated improvement in perinatal outcomes associated with gestational diabetes 23,24 ; so while a stable or rising HbA1c may be associated with adverse outcomes, it is not known if early treatment will prevent these adverse outcomes. Of note, postpartum carbohydrate metabolism was not assessed given that the primary study was done in an antenatal population.…”

Impacts of Hypoglycemia in At-Risk Infants on Admissions to Level-3 Neonatal Units in a Tertiary-Care Hospital

“…All pregnancies were screened for gestational diabetes between 24 and 28 weeks' gestation, using the clinical guidelines and standardized practices recommended by the American College of Obstetricians and Gynecologists. 22 The "oral glucose tolerance test" includes 100-g sugar. A diagnosis of gestational diabetes was made if the fasting blood glucose was ≥5.3 mmol/L, one-hour blood glucose ≥10.0 mmol/L, two-hour blood glucose ≥8.6 mmol/L, or three-hour blood glucose ≥7.8 mmol/L.…”